tag:blogger.com,1999:blog-26666124.post3377912346264426371..comments2016-12-07T04:27:23.529-05:00Comments on Shrink Rap: Suicide, Free Will, and the Shrink's Magical Ability to Predict ViolenceDinahnoreply@blogger.comBlogger83125tag:blogger.com,1999:blog-26666124.post-32360788192923626182012-02-02T05:16:17.822-05:002012-02-02T05:16:17.822-05:00I am a psychiatrist, and I agree with the sentimen...I am a psychiatrist, and I agree with the sentiment that involuntary hospitalization is not the answer to suicidal behavior. Hospitalization, in most environments I&#39;ve seen, is God awful: no place you would want to envision yourself or a loved one. I hate admitting someone voluntarily, especially if they&#39;re not psychotic. The reason we admit is because we HAVE TO. When you present to us in an ER in the wake of a botched attempt, or convey intent to die during an outpatient session, our hands are tied: we have to admit you, unless we want to subject ourselves to a career punctuated by law suits.<br /><br />I&#39;m a big believer in patient autonomy. I am an early career psychiatrists with a lot of doubts about what we can and can&#39;t do as a profession. I don&#39;t see much benefit in involuntarily admitting non-psychotic suicidal patients. It&#39;s often a revolving door that leads to dysfunctional relationship between that patient and the MH system as a whole. I think we should empower patients to be responsible for their own lives. I certainly think we should voluntarily admit patients who feel they require such for their own safety. I think we need more and improved outpatient safety plans (those would rely on a reliable social network, that&#39;s sadly not usually available).<br /><br />Listen, I didn&#39;t go into psychiatry to be a part of some gestapo. I don&#39;t feel the urge to save every mental health patient who doesn&#39;t want treatment. I feel, that as a doctor, the duty to care for <i>those who seek my care</i>. Should society have laws to involuntarily treat people? Perhaps, but that IMHO should be carried out by non-clinicians. I don&#39;t like the idea of a doctor--a healer--who deprives someone of his or her liberty and forces &quot;treatment&quot; upon them that they reject.Teufelhundenhttp://www.blogger.com/profile/17203040713990958656noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-11447642189901625262011-07-03T13:11:02.850-04:002011-07-03T13:11:02.850-04:00Late to this party, but here are a few thoughts:
...Late to this party, but here are a few thoughts:<br /><br />Suicide is the farthest &quot;downstream&quot; result of intolerable distressors. So predicting &quot;violence&quot; as a proxy for a suicidal act as prevention isn&#39;t leading anywhere.<br /><br />Going upstream to identify the distressors and to help identify who is separating from life might be more useful in developing resources to lower distress and to identify people who are alligning with thoughts of death.<br /><br />The two researchers doing that work are Thomas Joiner - he idnetified perceived burdensomeness and thwarted belongingness as the two key distressors - and <a href="http://www.wjh.harvard.edu/~nock/nocklab/publications.html" rel="nofollow">Matthew Nock</a> who developed the implicit attention test(IAT) for suicidal ideation.<br /><br />I&#39;ll provide links, but I&#39;m afraid that Blogger is really a new generation of PacMan - it gobbles them.<br /><br /><a href="http://www.psy.fsu.edu/~joinerlab/" rel="nofollow">Joiner</a> is a psychology professor at Florida State University, and his books are easy reads. His academic pubs are also key to developing further understanding.<br /><br />One thing that gets misunderstood is that people who commit suicide are trying to STOP pain/suffering. They are not trying further hurt themselves. Conflating these concepts has done a lot to keep research and treatment stuck in the middle ages.aekhttp://incompatiblewithlife.wordpress.comnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-33052457219964825252011-06-29T11:10:03.705-04:002011-06-29T11:10:03.705-04:00I believe it was either 1980 or 1981 the Supreme C...I believe it was either 1980 or 1981 the Supreme Court found that psychiatrist predicting the future violence/non-violence of patients for the benefit of criminal courts were wrong twice as often as they were right. In other words, the courts would be better on average if they didn&#39;t make predictions at all.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-86747875421550082082011-06-28T10:13:06.068-04:002011-06-28T10:13:06.068-04:00Sideways Shrink--I&#39;m not an M.D. but an attorn...Sideways Shrink--I&#39;m not an M.D. but an attorney. Under our Code of Professional Responsibility we&#39;re ethically required to report unethical conduct of other attorneys of which we become aware. It&#39;s a hard decision, probably even harder for an M.D. I&#39;ve done it on three occasions, all of which involved what I thought were pretty serious breaches of ethics. In all three cases, the attorneys involved got a slap on the wrist, though it&#39;s better than nothing. So these days I don&#39;t report these things any more. I suppose I would if there were actually criminal misconduct involved, or a client&#39;s interests were seriously damaged, but overall when I weigh the bad will accrued from reporting another attorney against the probability that the state bar association will actually take meaningful enforcement action, I&#39;ve decided that it&#39;s just not worth it.<br /><br />BTW--I was just joking with the &quot;sit at the grown-up table&quot; comment. Peace.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-36691418049608426142011-06-27T14:13:14.039-04:002011-06-27T14:13:14.039-04:00Sideways Shrink,
Has this patient asked you to re...Sideways Shrink,<br /><br />Has this patient asked you to report the other shrink? And also, did you have the patient&#39;s permission to look up her prior medication history through her insurance company on your EHR? What kind of power-of-attorney type of document does an insurance company need to release records like that to you?<br /><br />I&#39;m not a doctor, and I&#39;m wondering from your post where this woman&#39;s privacy rights come in. Can you complain to the state board without violating her rights? I&#39;m also wondering why the patient doesn&#39;t initiate the complaint against the other doctor.<br /><br />RHAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-3456432969084823132011-06-26T23:17:35.204-04:002011-06-26T23:17:35.204-04:00I am sorry for my rude post. I wish be even more ...I am sorry for my rude post. I wish be even more clear about my origin referrence to patients posting on Shrink Rap (not that I think my opinion is that important to anyone else). I have gained many insights from the patient&#39;s post on Shrink Rap and have learned something by observing the interactions between patients and between MDs and patients.<br /><br />Jesse<br /><br />Thank you for your advice. I have spoken to the patient, her husband, and a family friend (all 3 of whom spoke to the shrink about the medication caused and looked up the prescribing record through patient&#39;s insurance company on my EMR. It is the worst case of psychiatric practice I have ever seen up close. I have been waiting for my upset/anger to calm down before going to the state board.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-56204389392785716452011-06-24T21:14:21.072-04:002011-06-24T21:14:21.072-04:00Sideways wrote: &quot;For example, I would like to...Sideways wrote: &quot;For example, I would like to get advice from other shrinks on when to report another shrink to the state board for bad practice...&quot;<br /><br />Here&#39;s how I would look at it. A complaint to the state Board puts the license of the doctor in jeopardy. It should be reserved for a serious offense. It is a legal process. <br /><br />A complaint to the state medical society might put you in touch with other Shrinks with expertise in the area at hand. The state branch of the American Psychiatric Association likewise. <br /><br />Substance abuse: there are committees in all states I know of that deal with substance abuse and are connected to the state medical societie or the Boards. <br /><br />The best course in any event is to discuss the situation with other Shrinks with experience in the area of concern. Information gleaned from patients has to dealt with properly. If a patient wants to make a complaint about someone, in general our role is to help him in a neutral manner. This is particularly true in the case of ethical issues, such as sexual acts. We don&#39;t become the agent for our patient without strong reasons which should be thoroughly explored.jessehttp://www.blogger.com/profile/11077223398907532291noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-54207889644473873052011-06-24T19:25:47.651-04:002011-06-24T19:25:47.651-04:00There is no reason to be rude like that this. Not...There is no reason to be rude like that this. Nothing about it is productive and it is time to stop.<br /><br />It&#39;s good I raised two children.Dinahhttp://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-75237794794991646062011-06-24T18:50:18.978-04:002011-06-24T18:50:18.978-04:00Dear Sideways,
Do you believe that all doctors on...Dear Sideways,<br /><br />Do you believe that all doctors on a doctors only blog have only valuable insights, all of the time? If this blog is truly by and for psychiatrists ONLY then there should be a special secret link to sign in with your special secret number. Good thing the three shrinks let patients into the club because I am not sure their new book would sell very well to the doctors only community. It may not be tome-y enough for the inteeelechewal crowd that frequents bars for psychiatrists only.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-1415970634687281162011-06-24T17:49:41.451-04:002011-06-24T17:49:41.451-04:00Oh, well, too bad you didn&#39;t read my entire po...Oh, well, too bad you didn&#39;t read my entire post to see what actually bugs me. But now your failure to read my entire post in favor of leaping to assert that all patients have something important to say on a psychiatry blog by and for psychiatrists is bugging me because your innattention is providing an exemplar of the opposite of your assertion.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-28818432038012520232011-06-24T17:41:05.905-04:002011-06-24T17:41:05.905-04:00&quot;When I first discovered Shrink Rap, I hard h...&quot;When I first discovered Shrink Rap, I hard heartedly, selfishly thought I would mind the patients on Shrink Rap--that they would restrain the free dialogue among shrinks.&quot;<br /><br />But the really funny part about that comment is that pretty well every shrink I have ever met has been in therapy or is in therapy. And some commenters here are both patients and practicing shrinks.<br /><br />Not the Anon aboveAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-67286624822032702502011-06-24T17:37:47.622-04:002011-06-24T17:37:47.622-04:00About the Linehan post. You linked to a New York T...About the Linehan post. You linked to a New York Times article. It seemed more appropriate to comment there. I did, along with well over a hundred others. So, lots of comments on that post.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-10837894958270313632011-06-24T12:28:06.523-04:002011-06-24T12:28:06.523-04:00&quot;When I first discovered Shrink Rap, I hard h...&quot;When I first discovered Shrink Rap, I hard heartedly, selfishly thought I would mind the patients on Shrink Rap--that they would restrain the free dialogue among shrinks.&quot;<br /><br />Ah, those damn pesky patients, always trying to sit at the grown-up table and butt into the grown-up conversations among the shrinks!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-73094649584534911882011-06-24T12:06:36.461-04:002011-06-24T12:06:36.461-04:00Sarebear, Duane - thank you.
I can&#39;t solve th...Sarebear, Duane - thank you.<br /><br />I can&#39;t solve the world&#39;s problems (though that doesn&#39;t stop me from trying). I can, however, sometimes, make the world a little better, make things a little easier for individuals.<br /><br />I can - so how could I not do that if it&#39;s within my power? You matter.<br /><br />Hugs back atcha,<br />ZoeZoe Brainhttp://www.blogger.com/profile/13712045376060102538noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-16882879565524922082011-06-24T10:41:54.166-04:002011-06-24T10:41:54.166-04:00I am from Seattle, but trained in New York. When ...I am from Seattle, but trained in New York. When I came back I became familiar with Linehan and DBT through referrals from therapists. My lack of comment comes from the general feeling/surmising that Dr. Linehan&#39;s history is as she describes it based on her behavior/her previous disclosures. Who better to develop Dialectical Behavioral Therapy? She is the first psychologist to realize and describe that most women with borderline personality disorder were sexually or physically molested in early childhood. Linehan was the first in the English speaking world to deconstruct Freud&#39;s &quot;hysterics&quot; as, in fact, having been molested in the pre-verbal stage and emerging with cracked ego structures as this having caused their symptoms (not fantasies of sex with molestation per Freud). While building on his work, she has contributed more than Kernberg to the diagnosis and treatment of Borderline Personality Disorder. <br />I respect that she is publicly disclosing her own past. Though I am analytically trained and too young for it, I am drawn to the work of Sheldon Kopp: therapist and patient are both pilgrims on the same road. The Rogerian approach is no longer respected in psychiatry as psychiatry is under siege. However, such self disclosure is at the center of psychiatric training process. (I think one of the weaknesses of many psychology programs is that they do not require psychotherapy of their degree candidates.) <br />Linehan has done more for the treatment of those with borderline personality disorder since the diagnosis was codified.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-39687295227860149092011-06-24T10:05:12.816-04:002011-06-24T10:05:12.816-04:00Sideways, you could try sermo.com and webmd/medsca...Sideways, you could try sermo.com and webmd/medscape, which are restricted to docs, but alas you&#39;ll find a few psychiatry haters there too. Just have to take all the criticism with a grain of salt and see what you can learn from it.moviedochttp://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-85860558400286179502011-06-24T08:46:51.704-04:002011-06-24T08:46:51.704-04:00Shrink2Beeeee:
(that was fun)
Golden Gate Bridge -...Shrink2Beeeee:<br />(that was fun)<br />Golden Gate Bridge - Wikipedia, the free encyclopedia<br />Jump to Suicides‎: More people commit suicide at the Golden Gate Bridge than at any other site in the world. The deck is approximately 245 feet (75 m) ...<br />Suicide bridge - The Bridge (2006 film) - Verrazano-Narrows Bridge<br /><br />SidewaysShrink: <br />In May, our professional society hosted &quot;Whether, when, and how to report an impaired colleague&quot; I didn&#39;t go. Maybe another shrink here did? If anyone (shrinkwise that is) would like to guest post on the topic, email us.<br /><br />No one has comments on the post on Linehan? I think I messed up the original posting and it didn&#39;t go out to our RSS feeds right:<br />http://psychiatrist-blog.blogspot.com/2011/06/please-visit-hot-grand-rounds-summer.html<br />(I forgot to title it and it went out with the grand rounds title, oops)Dinahhttp://www.blogger.com/profile/09227988351623862689noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-49201564078645212722011-06-24T07:30:51.554-04:002011-06-24T07:30:51.554-04:00When I first discovered Shrink Rap, I hard hearted...When I first discovered Shrink Rap, I hard heartedly, selfishly thought I would mind the patients on Shrink Rap--that they would restrain the free dialogue among shrinks. But now I think what restrains actual free exchange of ideas and feeling it is the dogma of some of the compulsive, repeat bloggers. These non-shrinks, non-&quot;patients&quot; return to push anti-psychiatry agendas with very little feeling for what most of us who &quot;blog&quot; here to know to be the reality of human suffering. As a shrink, as a person, I know that we can all be patients, that all humans suffer at some time or another and can need someone to help us quite unexpectedly. This expertise can be in some area of health or human experience that we did not even know existed before that episode of illness or urgent pain. Why not form a blog of their own in which they espouse their own solutions or run for political office?<br />For example, I would like to get advice from other shrinks on when to report another shrink to the state board for bad practice without feeling that there is a gadfly mocking all of psychiatry in the room. But with avowed haters of psychiatry perched and waiting, how can any such mature dialogue take place? The practice of psychiatry is doubted, underpaid, and simply ignored most of the time. It would be a relief to have an open, honest forum.Sideways Shrinknoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-50891930309408372042011-06-24T01:34:10.657-04:002011-06-24T01:34:10.657-04:00Battle Weary: It&#39;s because the bridge is prett...Battle Weary: It&#39;s because the bridge is prettier than a picture of a detergent suicide. Looks do count no maater what people say.<br /><br />Leslie: I am sure one nurse on the unit I stayed was into the meds. Tried to give me a fraction of my dose. presuamble was going to pocket the rest. Called her on it. Got my proper dose. Of course she gave me all the right doses of the APs I was prescribed. I would have shared those. Spit them out anyway.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-58247287036229781032011-06-24T00:14:31.853-04:002011-06-24T00:14:31.853-04:00Shrink2B: I remember a study linking DENIAL of int...Shrink2B: I remember a study linking DENIAL of intent to kill oneself to suicide risk.moviedochttp://www.blogger.com/profile/03617061594621924756noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-47420635987073491152011-06-24T00:07:41.149-04:002011-06-24T00:07:41.149-04:00I have only skimmed the comments but hope to come ...I have only skimmed the comments but hope to come back later to thoroughly read them since I am actually currently using free will to not study for the human anatomy lab exam that I have in the am! <br /><br />A bit off topic...I am interested in knowing why such a large proportion of people choose the Golden Gate Bridge for a picture on blog posts that address suicide.Battle Wearyhttp://www.blogger.com/profile/01503957693970441332noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-80337659975650220172011-06-23T23:52:23.538-04:002011-06-23T23:52:23.538-04:00I&#39;ve been searching for a while for a study li...I&#39;ve been searching for a while for a study linking &quot;stated suicidal ideation&quot; with completed suicide - and I can&#39;t find one. I can find many other risk factors that are linked to suicide - but I can&#39;t find a single study that links the act of saying your going to kill yourself - to actually doing it.<br />I just know I thought many times on my psych rotations in med school that we were treating the wrong people. The people who say they are suicidal do need help - they are asking for help - but I don&#39;t think we are stopping many people from committing suicide by locking them up for 72 hours. We are helping those who cried out,but we can&#39;t find those who are actually going to kill themselves - it&#39;s very sad.Shrink2Bhttp://www.blogger.com/profile/06641627132872279262noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-23213246013639590682011-06-23T21:54:42.164-04:002011-06-23T21:54:42.164-04:00Anon, it is interesting how a cardiac patient woul...Anon, it is interesting how a cardiac patient would be allowed to make that decision. I made a similar observation while inpatient. I was hospitalized for being a danger to self. Yet, my nurse was a morbidly obese, type 2 diabetic, smoker. I think they should have been more concerned about that guy&#39;s lack of insight. <br /><br />Generally, society is ok with people killing themselves. They just frown on people doing it quickly.<br /><br />LeslieAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-26666124.post-88247084079849114052011-06-23T21:51:01.392-04:002011-06-23T21:51:01.392-04:00That is a beautiful and meaningful poem, Duane. T...That is a beautiful and meaningful poem, Duane. Thank you.<br /><br />I too am delighted by what Zoe Brain said; especially that she would take the time to write something so profound and caring.<br /><br />wv=layflu Um, what you do when you have the flu.Sarebearhttp://www.blogger.com/profile/09208596053319110470noreply@blogger.comtag:blogger.com,1999:blog-26666124.post-69109741297706754072011-06-23T20:48:46.969-04:002011-06-23T20:48:46.969-04:00Sarebear,
In the spirit of Zoe Brain&#39;s commen...Sarebear,<br /><br />In the spirit of Zoe Brain&#39;s comment, I hope you&#39;ll read the words to this poem... <br /><br />It is sent to you with sincere hope that you will begin to understand your own worth -<br /><br />http://www.kaleidoscopes.co.za/html/heavenlykiss.html<br /><br />Zoe Brain,<br /><br />I loved what you sent Sarebear!<br />I needed to be reminded that there are still some very caring people in this world!<br /><br />Thank you.<br /><br />DuaneDuane Sherry, M.S.http://discoverandrecover.wordpress.comnoreply@blogger.com